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Se presentan dos pacientes con diarrea crónica, con múltiples estudios negativos, y que tenían en común la deficiencia de vitamina B12. Ambos pacientes tenían estudios repetitivos de parásitos en heces negativos. Sólo al realizarse colonoscopía en el primer caso y la cápsula endoscópica en el segundo, se pudo diagnosticar formas adultas de Diphyllobotrium spp. Luego del tratamiento antiparasitario, ambos pacientes remitieron completamente sus síntomas.
We present two patients with chronic diarrhea, with multiple negative studies, both had in common vitamin B12 deficiency. Both patients had multiple studies of parasites in negative stool. Only after colonoscopy in the first case and capsule endoscopy in the second case, it was possible to diagnose the adult forms of Diphyllobotrium spp. After treatment, both patients completely resolved their symptoms.
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【Objective】 To evaluate the clinical value of capsule endoscope in the diagnosis of unexplained abdominal pain. 【Methods】 We made a retrospective analysis of 191 patients with unexplained abdominal pain who sought medical help in our hospital and 25 normal controls. Capsule endoscopy was performed in both groups, small bowel lesions were detected, and clinical data were collected for further analysis. 【Results】 The total small bowel lesion detection rate was 52.87% (101/191) in abdominal pain (AP) patients and 20% (5/25) in the control group, respectively. The detection rate of significant findings (ulcers, erosions, polyps, diverticula, parasites, and neoplastic organisms) was only 16.23% (31/191) in AP patients. In the non-significant findings, no statistical difference in the detection rates for vascular malformation, capillary dilation, and lymphoid follicular hyperplasia were found between the two groups, while the detection rate of intestinal lymphangiectasia was significantly higher in the AP patients (23.56% vs. 4%, P<0.05, OR=7.089). 【Conclusion】 Capsule endoscopy can be an optional choice for diagnosis of unexplained abdominal pain, while the relationship between positive findings and abdominal pain should be further investigated.
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Objective:To develop an improved wireless intelligent capsule cystoscope (WCE)for dynamic detection of bladder mucosa in a pig model.Methods:The WCE was introduced into a healthy experimental pig that under general anesthesia via urethra by applying an improved device. Multi-angle images of the bladder mucosa were then obtained by controlling the position of capsule cystoscope with an external magnetic field system. The shutter speed of the WCE was 2.5 fps and was automatically converted to 1.5 fps 30 minutes after initiation. The Vue software was utilized to download the shoot pictures which were former received by a computer via wireless transmission. The pig was roused and sent to the pigpen, without limitations in moving. The improved WCE was connected with a 2 cm thread. 12 hours later, the dilated sheath was inserted again, and the capsule was removed by a foreign body forceps under observation of a ureteroscopy.Results:The WCE was successfully placed and removed from the pig's bladder with the application of the improved devices. Over 20 thousand images that with 60K pixels of bladder mucosa were captured by the WCE at various angles within 12 hours, which revealed the process of urine filling and excreting in a time-dependent way. No notable adverse effects (bleeding, urinary tract injury, etc) were noted during the process of cystoscope placement, image acquisition, transmission, and removal.Conclusion:This study developed a novel WCE that could dynamically, intelligently and accurately monitor all aspects of the pig bladder mucosa, and has preferable application prospect.
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Wireless network is the fast-growing technology. The world is moving towards the wireless technology and it is used each and everywhere. Wireless network is used in many ways and one of the applications is medical application. In wireless technology, Antennas play an important role in data transmission. Antennas are electronic eyes and ears of humans in the modern world. There are many applications of antenna in medical field. One of the applications is data transmission in wireless capsule endoscopy. Wireless capsule endoscopy is the advancement of wired endoscopy. Wireless capsule endoscopy is used to diagnose the problems in the gastro intestinal tract, stomach and intestines which cannot be identified from outer observation or through x-rays or any other tests. The doctors watch the travel of capsule in the display and diagnose the problems which will be easier for the treatment. The types of antennas in medical field are Ingestible antennas, On body wearable Antennas, Implantable antennas, Antenna for MRI, Microwave Imaging, Thermal Ablation. For wireless data transmission in wireless capsule endoscopy, Microstrip patch (MSP) antenna is designed using Duroid as substrate in the frequency of 2.45 GHz with efficiency of 88% and gain of 4.86 dB. Microstrip patch antenna is selected as it is smaller in size which is most important characteristic of capsule endoscopy. In MSP antenna, copper is used for ground and patch, Duroid is used as the dielectric medium for the substrate as it gives higher efficiency, higher gain and higher directivity.
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Background: Video capsule endoscopy (VCE) is a valuable diagnostic tool for the evaluation of the small intestine. Evidence shows that it is effective in the diagnosis of occult bleeding and superficial lesions that are not radiographicallyobserved. We evaluated the efficacy and safety of the capsule endoscopy in the diagnosis and management of the common gastrointestinal disorders.Methods: A retrospective chart review of a total of 326 candidates who have met the inclusion criteria and who underwent VCE from the period from January 2006 till December 2018.Results: The main indication for Video Capsule Endoscopy was small bowel overt gastrointestinal bleeding with 106 cases (32.6%) followed by iron deficiency anemia with 104 cases (32%). Capsule retention rate was observed in 11 cases (3.4%) 4 of which were crohn抯 disease patients (22.2%). Overall diagnostic yield was 36%, 64% for overt gastrointestinal bleeding and 41% for occult gastrointestinal bleeding. The most common reported positive finding was Angiodysplasia in 19.9% of cases, followed by ulcers in 13.8% of cases, followed by polyps in 8.3% of cases and erosions in 8% of cases.Conclusions: Video capsule endoscopy proved to be an essential diagnostic tool in gastrointestinal bleeding. Advantages of VCE include; less labor, higher resolution examination of mucosa, relative safety, and noninvasiveness. On the other hand, it does not offer intervention capabilities when compared with enteroscopy and its interpretation was sometimes difficult and time consuming. Risk of capsule retention remains significant especially in patients suffering from crohn抯 disease.
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Abstract Introduction: The prevalence of iron deficiency anemia in developed countries has been estimated between 2-5 %, associated with high morbidity and mortality. Etiological identification is sometimes difficult and requires diagnostic methods, such as video capsule endoscopy (VCE). Aim: This study intends to characterize the findings of this technique in patients with unexplained iron deficiency anemia. Materials and methods: Descriptive observational retrospective study. We describe the VCE findings (PillCamSB2-SB3) in all patients seen between 2011 and 2019. The findings were interpreted according to the Saurin classification: normal (P0), uncertain potential (P1), and high bleeding potential (P2). Results: Of the 490 VCEs performed during the study period, 155 indicated iron deficiency anemia; 106 were women (68.4 %), and the mean age was 57.1 ± 16.6 years. The main comorbidities were cardiovascular in 23 (18.3 %) and arterial hypertension in 16 (12.6 %). Antiplatelets were present in 18 (15.4 %) and anticoagulants in six (5.1 %). Small bowel lesions were vascular in 44 studies (28.4 %), inflammatory in 33 (21.2 %), and neoplastic in seven (4.5 %). Angiectasias were the most frequent lesions in 33 cases (21.3 %). P2 lesions were present in 53 VCEs (34.2 %). Conclusions: VCE is helpful in the study of iron deficiency anemia and helps detect positive findings in the midgut in three out of four patients for which it is indicated. The most frequent significant P2 lesions were vascular. These findings allow providing adequate treatment.
Resumen Introducción: la prevalencia de la anemia ferropénica en países desarrollados se ha estimado entre 2 %-5 %, asociada con una alta morbimortalidad. La identificación etiológica a veces es difícil, y requiere de métodos diagnósticos, como la videocápsula endoscópica (VCE). Objetivo: el objeto del presente estudio fue caracterizar los hallazgos de esta técnica en pacientes con anemia ferropénica inexplicada. Materiales y métodos: estudio descriptivo, observacional y retrospectivo. Se describen los hallazgos de VCE (PillCamSB2-SB3) en todos los pacientes atendidos entre 2011 y 2019. Los hallazgos se interpretaron según la clasificación de Saurin: normal (P0), potencial incierto (P1) y alto potencial de sangrado (P2). Resultados: del total de 490 VCE realizadas durante el período del estudio, 155 se efectuaron con indicación de anemia ferropénica; 106 fueron mujeres (68,4 %) y la edad media fue de 57,1 ± 16,6 años. Las comorbilidades principales fueron cardiovasculares en 23 (18,3 %) e hipertensión arterial en 16 (12,6 %). La ingesta de antiplaquetarios se presentó en 18 (15,4 %) y anticoagulantes en 6 (5,1 %). Las lesiones en el intestino delgado fueron vasculares en 44 estudios (28,4 %), inflamatorias en 33 (21,2 %) y neoplásicas en 7 (4,5 %). Las angiectasias fueron las lesiones más frecuentes en 33 casos (21,3 %). En 53 VCE se presentaron lesiones P2 (34,2 %). Conclusiones: la VCE es útil en el estudio de la anemia ferropénica, y ayuda a detectar hallazgos positivos en el intestino medio en 3 de cada 4 pacientes en los cuales se indica su uso. Las lesiones P2 significativas más frecuentes fueron las vasculares. Estos hallazgos permiten enfocar un tratamiento adecuado.
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Humanos , Masculino , Feminino , Anemia Ferropriva , Endoscopia por Cápsula , Intestino Delgado , Pacientes , Estudos Retrospectivos , Hemorragia , AnticoagulantesRESUMO
Objective:To explore the value of detachable string-magnetically controlled capsule endoscopy (DS-MCE) in the evaluation of post-endoscopic treatment of liver cirrhosis patients with gastroesophageal varices during follow-up, and conventional electronic esophagogastroduodenoscopy (EGD) was used as the gold standard.Methods:From July 1, 2019 to December 31, 2021, 50 follow-up patients with gastroesophageal varices due to liver cirrhosis and had a past medical history of endoscopic treatment in Ruijin Hospital, Shanghai Jiaotong University School of Medicine were selected. DS-MCE and EGD were performed in turn. The 2 endoscopic examination methods were compared and analyzed in the assessment of detecting gastroesophageal varices, grading of diameter of esophageal varices and classification of bleeding risk factors (including sensitivity, specificity, positive predictive value and negative predictive value), diagnosis of portal hypertensive gastropathy and its severity, and the patients′ satisfaction (pre-procedural perceptual and post-procedural satisfaction). Kruskal-Wallis test and Kappa test were used for statistical analysis.Results:The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices were 100.0% (43/43), 85.7%(6/7), 97.7% (43/44) and 100.0%(6/6), respectively.The accuracy of DS-MCE in evaluating the grading of esophageal varices was 86.0% (43/50), with good consistency of EGD, and the Kappa value was 0.797 ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices with bleeding risk factors were 94.4% (34/36), 100.0%(14/14), 100.0% (34/34) and 87.5%(14/16), respectively. The accuracy of DS-MCE in evaluating esophageal varices with bleeding risk factors was 94.0% (47/50), with good consistency of EGD, and the Kappa value was 0.862 ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of gastric varices were 85.7% (18/21), 93.1% (27/29), 90.0% (18/20) and 90.0% (27/30), respectively. The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of portal hypertensive gastropathy were all 100.0% (50/50). The consistency of DS-MCE and EGD in the severity grading of portal hypertensive gastropathy was good, the Kappa value was 0.962 ( P<0.001). The results of pre-procedural perceptual analysis showed that patients′ psychological tension before examination and expected pain before examination of DS-MCE were better than those of EGD ( H=16.04 and 23.74, both P<0.001). The results of satisfactory analysis after examination indicated that DS-MCE was better than EGD in the degree of difficulty in swallowing, pain and discomfort during examination, pain and discomfort after examination, comfort degree during examination, convenience of the procedure and willingness of receiving such examination again as gastric examination method ( H=17.28, 30.88, 44.68, 34.66, 48.05, 22.74, 13.03 and 17.19, all P<0.001). Conclusions:With EGD as the gold standard, DS-MCE can accurately evaluate gastroesophageal varices and portal hypertensive gastroenteropathy after endoscopic treatment in patients with liver cirrhosis and gastroesophageal varices, and it is a safe and comfortable method. DS-MCE can be an efficient alternative method in endoscopic follow-up of such patients.
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Objective:To investigate the application value of magnetic-controlled capsule endoscopy (MCE) for small intestine disease screening in physical examination population.Methods:Physical examination data of 1 230 individuals who received MCE examination from January to December 2019 in institute of Health Management were collected and retrospectively analyzed, and then divided into the gastrointestinal symptoms group and the group without gastrointestinal symptoms. Statistical analysis included the completion rate of MCE, the detection rate for small intestine disease in two groups, the relation between the gastrointestinal symptoms and small intestine diseases.Results:The mean age of the subjects was (54.4±17.3) years. The success rate of completion was 99.43%, and the detection rate of intestine diseases was 30.09%(368/1 230). Different genders and symptoms had no effect on the passage time of MCE through the small intestines, but the passage time of MCE through the small intestines in the age group younger than 50 years old [(242.9±88.7) min] was significantly less than in the age group greater than or equal to 50 years old [(336.4±112.1) min]( P<0.05). The detection rate of a duodenal bulbal ulcer and duodenitis was 1.73% (11/635) and 6.14% (39/635) respectively, in the symptomatic group, which were significantly higher than in the asymptomatic group 0.17%(1/595)及2.02%(20/595)( P<0.05). However, there was no significant difference in the detection rate of positive lesions between the two groups. Conclusion:There is a certain incidence of small intestinal diseases in people undergoing physical examinations. Magnetic-controlled capsule endoscopy can effectively complete the screening and diagnosis of small intestinal diseases while completing stomach examination, which is an effective tool for early diagnosis and prevention of small intestinal diseases in people undergoing physical examinations.
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Capsule endoscopy is one of the main diagnostic methods of small bowel diseases. In small bowel capsule endoscopy, the main factors that influence the diagnostic rate of diseases include gastrointestinal examination completion rate and intestinal preparation, etc. The upper gastrointestinal transit time is one of the main influence factors of examination completion rate. This article reviewed risk factors and clinical management of prolonged upper gastrointestinal transit time in capsule endoscopy.
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Small-bowel capsule endoscopy has been widely used in clinical practice and become the first-line method for diagnosing of small - bowel disorders. In order to standardize the examination procedure of small - bowel capsule endoscopy, clarify the indications and contraindications, on the basis of clinical practice in China, National Clinical Research Center for Digestive Diseases (Shanghai), National Digestive Endoscopy Improvement System, Capsule Endoscopy Collaborative Group of Chinese Society of Digestive Endoscopology, and Capsule Endoscopy Group of Digestive Endoscopy Branch of Shanghai Medical Association organized domestic experts in relevant fields to search and discuss relevant literatures at home and abroad. The quality of evidence and strength of recommendations were rated using the grading of recommendations assessment, development, and evaluation (GRADE) method. The reporting items for practice guidelines in healthcare (RIGHT) were followed to develop this guideline for providing guidance and decision-making basis for Chinese physicians.
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Small bowel bleeding is defined as bleeding from the gastrointestinal tract where the cause cannot be clearly identified after routine gastroscopy and colonoscopy, of which bleeding visible to the naked eye is classified as overt bleeding. Endoscopy, such as capsule endoscopy and device⁃assisted enteroscopy, occupies a dominant position in the diagnosis of overt small bowel bleeding, and how to choose the right time for endoscopy is closely related to the diagnostic yield. This article provided an overview of the timing and diagnostic role of early capsule endoscopy and device⁃assisted enteroscopy in overt small bowel bleeding.
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【Objective】 To compare the clinical value of magnetic-controlled capsule endoscopy （MCE） and traditional capsule endoscopy （CE） in the diagnosis of intestinal diseases in hospitalized patients. 【Methods】 A single-center retrospective study was conducted in 263 inpatients who underwent MCE and CE in The First Affiliated Hospital of Xi’an Jiaotong University from March 2016 to March 2020. The information included the patients’ general data， chief complaints， and results of capsule endoscopic examination. 【Results】 ① The overall detection rate in small intestinal diseases was 74.45% in MCE group and 73.81% in CE group， respectively （P=0.905）. The three most common diseases in the two groups were erosive/ulcerative lesions， vascular lesions， and lymphangiectasia. ② The endoscopic auxiliary rate was significantly lower in MCE group than in CE group （0% vs. 9.49%， P<0.001）. ③ There was no significant difference in the rate of intestinal incompletion between the two groups （7.94% vs. 13.87%， P=0.185）. 【Conclusion】 MCE is similar to CE in the diagnostic value for intestinal diseases. Currently， it can be used as one of the methods of small intestinal examination， but this needs to be supported by more multicenter and sizable simple studies.
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Resumen Introducción: el estudio de intestino delgado es un desafío, motivo de avance médico y de interés. La enteroscopia de doble balón (EDB) permite una visualización directa del intestino delgado. Objetivo: describir indicaciones, características del procedimiento, hallazgos, complicaciones y seguimiento de pacientes llevados a EDB en el Hospital de San José de Bogotá, entre noviembre de 2011 y abril de 2019. Metodología: estudio de serie de casos. Se incluyeron pacientes con indicación clínica o por imágenes diagnósticas sugerentes de lesión a nivel de intestino delgado. Se empleó estadística descriptiva. Resultados: se realizaron 45 enteroscopias a 44 pacientes, con una mediana de edad de 58 años. La principal indicación fue hemorragia digestiva potencial de intestino delgado (53,3 %) y diarrea crónica (11,1 %); fueron más frecuentes los procedimientos por vía anterógrada. La mayoría de los resultados fue normal (46,7 %); entre los hallazgos más frecuentes estuvieron los tumores (11,1 %), enfermedad de Crohn (8,9 %) y úlceras/erosiones (6,7 %). El rendimiento diagnóstico fue 53,3 %, la correlación con la videocápsula endoscópica (VCE) fue 37,5 % y con estudios de imagen, 42,9 %. No se presentaron complicaciones. Se hizo seguimiento al 91,1 % de los pacientes con una mediana de 56 meses y se observó la resolución de síntomas en el 78,1 %. La finalidad de la enteroscopia fue diagnóstica en el 84,4 %. Conclusiones: La EDB es útil en la evaluación del intestino delgado con posibilidad terapéutica. Los resultados son similares a los reportados en la literatura mundial. Si se realiza seguimiento, se puede definir la necesidad de repetición del procedimiento, realización de estudios adicionales u observar resolución de los síntomas.
Abstract Introduction: The study of the small bowel is a challenging task that has sparked interest and progress in medicine. In this context, double balloon enteroscopy (DBE) has allowed the direct visualization of the small intestine. Objective: To describe indications, procedure characteristics, findings, complications, and follow-up of patients taken to DBE at the Hospital de San José, Bogotá, between November 2011 and April 2019. Methodology: Case series study. Patients with a clinical indication or diagnostic images suggestive of small bowel lesion were included. Descriptive statistics were used. Results: 45 enteroscopies were performed in 44 patients, with a median age of 58 years. The main indication was potential small bowel bleeding (53.3%) and chronic diarrhea (11.1%). Anterograde procedures were more frequent. Most of the results were normal (46.7%); tumors (11.1%), Crohn's disease (8.9%), and ulcers/erosions (6.7%) were among the most frequent findings. The diagnostic yield was 53.3% and the correlation with capsule endoscopy (CE) was 37.5%, and with imaging studies 42.9%. There were no complications. 91.1 % of patients were followed up on after a median of 56 months, with 78.1 % reporting symptom remission. The aim of enteroscopy was diagnostic in 84.4%. Conclusions: DBE is useful in the evaluation of the small intestine with a therapeutic possibility. The results are similar to those reported in the world literature. Follow-up can define the need for repeating the procedure, performing further studies, or symptom resolution.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Enteroscopia de Duplo Balão , Hemorragia , Pacientes , Intestino DelgadoRESUMO
The diagnosis of neuroendocrine tumors of the small intestine is usually challenging. They are infrequent, and the clinical course is insidious with nonspecific manifestations. Routine endoscopic and abdominal imaging studies are more often unremarkable. Therefore, distant metastases are frequently detected at the time of diagnosis. The tumor markers chromogranin A, synaptophysin, and neuron-specific enolase, and capsule endoscopy, and device-assisted enteroscopy are useful resources to establish a diagnosis. The aim was to present a case of neuroendocrine tumor of small intestine diagnosed with base in findings of the capsule endoscopy and further open surgery.
El diagnóstico de tumores neuroendocrinos del intestino delgado suele ser un desafío. Son infrecuentes y el curso clínico es insidioso con manifestaciones inespecíficas. Los estudios de imágenes endoscópicos y abdominales de rutina suelen ser anodinos. Por tanto, las metástasis a distancia se detectancon frecuencia en el momento del diagnóstico. Los marcadores tumorales cromogranina A, sinaptofi-sina y enolasa neuronal específica, y la cápsula endoscópica y la enteroscopía asistida por dispositivo son recursos útiles para establecer un diagnóstico. El objetivo de este trabajo fue presentar un caso de tumor neuroendocrino de intestino delgado diagnosticado con base en hallazgos de la cápsula endoscópica y de una nueva cirugía abierta.
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Humanos , Feminino , Pessoa de Meia-Idade , Relatos de Casos , Tumores Neuroendócrinos , Endoscopia por Cápsula , Cirurgia Geral , Diagnóstico , Neoplasias Gastrointestinais , Intestino DelgadoRESUMO
Objective:To investigate the application value of magnetic-controlled capsule endoscopy (MCE) for small intestine disease screening in physical examination population.Methods:Physical examination data of 1 230 individuals who received MCE examination from January to December 2019 in Health Research institutes were collected and retrospectively analyzed, and then divided into the gastrointestinal symptoms group and the group without gastrointestinal symptoms. Statistical analysis in cluded the completion rate of MCE, the detection rate for small intestine disease in two groups, the relation between the gastrointestinal symptom and small intestine diseases.Results:The mean age of the subjects was (54.4±17.3) years. The success rate of completion was 99.43%, and the detection rate of intestine diseases was 30.09%(368/1 230). Different genders and symptoms had no effect on the passage time of MCE through the small intestines, but the passage time of MCE through the small intestine in the age group younger than 50 years old [(242.9±88.7) min] was significantly less than in the age group greater than or equal to 50 years old [(336.4±112.1) min]( P<0.05). The detection rate of a duodenal bulbal ulcer and duodenitis was 1.73% (11/635) and 6.14% (39/635), respectively, in the symptomatic group, which were significantly higher than in the asymptomatic group 0.17%(1/595)及2.02%(20/595)( P<0.05). However, there was no significant difference in the detection rate of positive lesions between the two groups. Conclusion:There is a certain incidence of small intestinal diseases in people undergoing physical examinations. Magnetic-controlled capsule endoscopy can effectively complete the screening and diagnosis of small intestinal diseases while completing stomach examination, which is an effective tool for early diagnosis and prevention of small intestinal diseases in people undergoing physical examinations.
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OBJECTIVE@#To investigate the effects of Weikang Capsule (, WKC) on aspirin-related gastric and small intestinal mucosal injury by magnetically controlled capsule endoscopy (MCCE).@*METHODS@#Patients taking enteric-coated aspirin aged 40-75 years were enrolled in Beijing Anzhen Hospital, Capital Medical University from January 2019 to December 2019. The patients continued taking aspirin Tablet (100 mg per day) and underwent MCCE before and after 1-month combined treatment with WKC (0.9 g per time orally, 3 times per day). The gastrointestinal symptom score, gastric Lanza score, the duodenal, jejunal and ileal mucosal injury scores were used to evaluate the gastrointestinal injury before and after treatment. Adverse events including nausea, vomiting, abdominal pain, abdominal distension, abdominal discomfort, dizziness, or headache during MCCE and combined treatment were observed and recorded.@*RESULTS@#Twenty-two patients (male/female, 13/9) taking enteric-coated aspirin aged 59.5 ± 11.3 years with a duration of aspirin use of 28.0 (1.0, 48.0) months were recruited. Compared with pre-treatment, the gastrointestinal symptom rating scale scores, gastric Lanza scores, and duodenal mucosal injury scores were significantly reduced after 1-month WKC treatment (P<0.05), and jejunal and ileal mucosal injury scores showed no obvious change. No adverse events occurred during the trial.@*CONCLUSIONS@#WKC can alleviate gastrointestinal symptoms, as well as gastric and duodenal mucosal injuries, in patients taking enteric-coated aspirin; it does not aggravate jejunal or ileal mucosal injury, which may be an effective alternative for these patients (Clinical trial registry No. ChiCTR1900025451).
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Meckel's diverticulum can be present in up to 1.2% of the population. It is usually diagnosed as an imaging finding, but it can present with complications such as digestive bleeding, intestinal obstruction, diverticulitis, ulcers, and perforation, more frequently in childhood or infancy. The diagnosis workup for this condition will depend on their clinical manifestation, the most frequent being gastrointestinal bleeding of obscure origin or small intestinal bleeding. In this context, although capsule endoscopy is the preferred technique, its diagnostic yield for the detection of Meckel's diverticulum is not entirely clear and it has not been compared in a controlled studies with other diagnostic methods. Here we report the diagnosis of a Meckel diverticulum and its intestinal complications by means of capsule endoscopy in a patient with iron deficiency anemia and gastrointestinal bleeding
El divertículo de Meckel puede estar presente en el 1,2% de la población general. Usualmente es diagnosticado como un hallazgo, pero puede presentarse con mayor frecuencia en la niñez o infancia por sus complicaciones como hemorragia digestiva, obstrucción intestinal, diverticulitis, úlceras y perforación. El enfrentamiento diagnóstico de esta condición dependerá de la manifestación clínica, siendo lo más frecuente hemorragia digestiva de origen oscuro o de intestino delgado. En este contexto, si bien la cápsula endoscópica es la técnica de elección, su rendimiento diagnóstico para la detección del divertículo de Meckel no es del todo claro y no ha sido comparado de forma controlada con otras técnicas diagnósticas. En el presente caso se reporta el diagnóstico de un divertículo de Meckel y sus complicaciones intestinales mediante cápsula endoscópica en una paciente con anemia ferropriva y hemorragia digestiva.
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Humanos , Feminino , Adolescente , Endoscopia por Cápsula/métodos , Divertículo Ileal/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Resumen En pacientes sin una causa clara de sangrado gastrointestinal luego de una endoscopia digestiva alta y baja, la causa se encontrará en el intestino delgado hasta en el 77 % de los casos. Ante el excelente rendimiento diagnóstico de la videocápsula endoscópica (VCE) para el estudio de este segmento del tracto gastrointestinal, surge la duda de si debería ser el método diagnóstico inicial de este grupo de pacientes con posible sangrado del intestino delgado (PSID) o si la realización de una nueva endoscopia alta y baja o algún método alternativo de estudio del intestino delgado debería serlo. En esta revisión se evalúa y evidencia el rendimiento diagnóstico superior y la mayor seguridad de la VCE como abordaje inicial de pacientes con PSID en relación con otros métodos. Sin embargo, se pone en tela de juicio la mejor costo-efectividad de este abordaje en nuestro medio, que en otros ha sido claramente demostrada.
Abstract When neither upper nor lower gastrointestinal endoscopy can find a clear cause of gastrointestinal bleeding, it will eventually be found in the small intestine in up to 77% of cases. Given the excellent diagnostic performance of video capsule endoscopy for studying this segment of the gastrointestinal tract, the question of whether it should become the initial diagnostic method for patients with possible bleeding from the small intestine arises. The alternatives are to perform additional upper and lower endoscopic procedures or to use some alternative method of studying the small intestine. This review documents and evaluates the superior diagnostic performance and greater safety of videocapsule endoscopy as the initial approach for possible bleeding from the small intestine and compares it with other methods. However, the cost-effectiveness of this approach, clearly demonstrated elsewhere, is questioned in our setting.
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Humanos , Efetividade , Endoscopia por Cápsula , Hemorragia , Intestino DelgadoRESUMO
Objective@#To analyze the clinical value of capsule endoscopy (CE) in small intestinal diseases and to explore the correlation between the diagnosis and clinical characteristics.@*Methods@#From June 2016 to April 2019, a total of 194 patients receiving CE were enrolled in the Department of Gastroenterology, Shanxi People′s Hospital, including 68 patients with obscure gastrointestinal bleeding, 104 with chronic abdominal pain and 22 with diarrhea.@*Results@#The detection rate of small intestinal lesions by CE was 53.6%(104/194), of which gastrointestinal bleeding was 66.2% (45/68), chronic abdominal pain was 53.8%(56/104), and diarrhea was 13.6%(3/22). The first three positive diagnostic criteria of CE for gastrointestinal bleeding were non-specific inflammation, small intestinal ulcer and vascular malformation. CE findings in patients with abdominal pain were non-specific inflammation, small intestinal ulcer and Crohn′s disease; while the major endoscopic presentations in patients with diarrhea were small intestinal ulcer and non-specific inflammation. Logistic regression analysis suggested that the clinical manifestations and gender were correlated with positive diagnosis by CE (P<0.05), and the positive diagnostic rate of CE in female patients was significantly lower than that in male patients [31.6%(25/79) vs. 51.3%(59/115), P<0.05]. The diagnostic rates of CE in patients with gastrointestinal bleeding and chronic abdominal pain were similar [55.9%(38/68) vs. 41.4%(43/104)], which was significantly higher than those with diarrhea [9.1%(2/22), P<0.05].@*Conclusions@#Capsule endoscopy has a high detection rate for small intestinal diseases, which could be the first choice in patients with unexplained gastrointestinal bleeding. Male patients and gastrointestinal bleeding are predictors of positive findings by CE.
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Objective@#To explore the clinical applications of second generation colon capsule endoscopy (CCE-2).@*Methods@#From July 2017 to December 2018, at the First Affiliated Hospital, College of Medicine, Zhejiang University, 40 outpatients and hospitalized patients who underwent CCE-2 examination were enrolled. The examination results were analyzed by an expert gastroenterologist with rich experience in small intestinal and colon capsule endoscopy. The stomach, small bowel and colon transit time, the score of colon cleansing quality, the completion rate of colon capsule examination, lesion detection and adverse effects were observed. Chi-square test and Student′t test were used for statistical analysis.@*Results@#The whole gastrointestinal tract examination was completed during the capsule running time in 65.0% (26/40) of the patients. The average stomach transit time was (0.92±0.74) h, the small bowel transit time was (3.93±1.51) h and the colon transit time was (4.89±0.61) h. The capsule running time of patients who completed the whole gastrointestinal tract examination was shorter than that of patients who did not complete the whole gastrointestinal tract examination ((9.44 ± 3.53) h vs. (15.47±2.09) h), and the difference was statistically significant (t=6.79, P<0.01). The qualified rate of colon preparation was 67.5% (27/40). There were no statistically significant differences in colon transit time or capsule excretion time between patients with qualified colon preparation and poor colon preparation ((4.43±3.33) h vs. (5.96 ± 2.44) h; and (9.06 ± 3.91) h vs. (10.29±2.47) h; t=1.17 and 0.81, both P>0.05). A total of 33 (82.5%) patients had gastrointestinal lesions detected by colon capsule, including three cases of esophageal lesions (inflammation and mass), 21 cases of gastric lesions (chronic gastritis, mucosal protrusion, polyp and ulcer), nine cases of small bowel lesions (polyp, ulcer and vascular malformation) and 19 cases of colonic lesions (diverticulum, polyp, rectitis, mucosal erosion, ulcer and vascular malformation, internal hemorrhoids). Among them, there were 11 patients with two or more lesions. No adverse events occurred during the examination and all the capsules were excreted within 48 hours.@*Conclusion@#CCE-2 with high safety and good tolerance can be used for whole gastrointestinal tract examination.